Premera Blue Cross

Security Engineer

• Respond to cybersecurity alerts and conduct investigations into security threats
• Protect Premera’s sensitive personal and financial data from threat actors
• Identify, respond to, and investigate daily attacks targeting Premera data
• Apply threat hunting and analysis skills to cybersecurity investigations
• Engineer solutions to prevent damaging cyber threats
• Address threats from nation-state actors, cybercriminal organizations, and insider threats
• Contribute to Premera’s Security Awareness Program through written communication and public speaking
• Conduct forensic analysis to proactively stop cybersecurity threats from the Premera network
• Work in a structured team environment

Cybersecurity Threat Response Engineer III

Full-stack Engineer

• Confer with stakeholders and IT leaders to understand business problems or improvement opportunities and identify software solutions
• Analyze moderate-risk business needs to determine solutions
• Design solutions on various platforms by studying requirements and information needs
• Translate moderately complex system requirements into code using multiple programming languages and/or tools
• Develop and modify code and system setup based on program specifications
• Apply CI/CD
• Perform unit testing and test automation and document test results
• Participate in testing for cross-functional project teams
• Produce technical documentation and notifications for production changes or fixes
• Create SDLC artifacts
• Analyze and resolve moderate-risk production problems, including performance tuning, troubleshooting, debugging, call rotation, and root cause analysis
• Support project initiatives and collaborate with the design team to meet development milestones and deadlines
• Provide feedback to peers on designs
• Provide input to IT process standardization and ensure application of IT standards and requirements
• Participate in continuing education and improve knowledge of Premera’s business and relevant technologies

Software Development Engineer II

Human Resources

• Build consultative relationships with assigned operational divisions and understand their business, workforce, and people priorities
• Advise and coach leaders on performance management, organizational design, employee engagement, talent planning, change management, and HR policies and practices
• Partner with leaders, senior HR Business Partners, and Human Capital partners to assess needs and develop practical people strategies
• Support leaders and employees with workplace concerns, HR program questions, policy interpretation, performance matters, conduct concerns, time and attendance issues, and employee-relations needs
• Coach leaders through difficult conversations and partner with Employee Relations and subject matter experts
• Maintain knowledge of employment laws and legal requirements, identify potential risks, and promote consistent application of policies and practices
• Use data, trends, and business context to inform recommendations and influence people-related decisions
• Help leaders prioritize work and establish processes or controls that improve team effectiveness and capacity
• Provide input on HR programs, initiatives, and policies, and identify improvement opportunities through technology, automation, and AI-enabled solutions
• Build credibility and trust by listening, seeking context, demonstrating curiosity, and adapting support to business needs
• Partner across Human Capital and the broader organization to connect leaders with resources, expertise, and solutions
• Communicate clearly and effectively with employees and leaders at multiple organizational levels

HR Business Partner

Medical Director

• Provide benefit coverage determinations based on medical necessity and contract language
• Review clinical documentation using medical policy criteria, guidelines, and member contracts
• Support clinical programs including disease management and case management
• Support pre-service, post-service, concurrent facility-based care, and transitions between levels of care reviews
• Make final coverage decisions based on medical necessity, investigational status, contractual exclusions, or network structure
• Use clinical expertise to support claims review decisions involving level of care, pricing, complexity assessment, dependent disability status, and by-report procedure payment determinations
• Support peer-to-peer discussions with external physicians and providers regarding denial determinations and collect additional clinical history
• Consult with nursing and clinical staff regarding care options for members in clinical programs
• Participate in development, annual review, and approval of company medical review criteria through the Premera Medical Policy Committee
• Support ongoing education for clinicians involved in medical review
• Provide professional consultation to Premera Blue Cross and contracted practitioners/facilities
• Participate in the Inter-Rater Review process to ensure consistency in clinical decision-making
• Comply with applicable federal, state, and accreditation regulations and standards
• Complete continuing education and participate in ongoing education and training

Assistant Medical Director – Utilization Review

• Perform clinical review of pre-service, post-service, and concurrent behavioral health services
• Review outpatient and facility-based behavioral health cases
• Consult with clinical staff on specific case reviews
• Make final coverage decisions based on medical necessity, investigational status, contractual exclusions, or network structure
• Support peer-to-peer discussions with external physicians and providers regarding denial determinations
• Collect additional clinical history relevant to case determinations
• Consult with nursing and other clinical staff to assess and explore care options for members
• Participate in development, annual review, and approval of company medical review criteria as a Premera Medical Policy Committee member
• Participate in Inter-Rater Reliability evaluations
• Respond to consultation requests from Premera Blue Cross and contracted practitioners and facilities
• Support member and provider appeals and conduct secondary reviews as needed
• Fulfill professional continuing education requirements and participate in ongoing education and training

Assistant Medical Director – Behavioral Health Focus

Clinician

• Evaluate clinical requests from providers to determine whether care is medically appropriate and aligned with established criteria and protocols
• Conduct inpatient, concurrent, benefit advisory/prior authorization, retrospective, out-of-network, and treatment-setting medical necessity reviews
• Assess medical necessity of inpatient admissions, outpatient services and procedures, benefit applications, and out-of-network provider requests
• Consult with Medical Directors when requested care does not meet applicable criteria or policies
• Document clinical information completely, accurately, and on time
• Meet or exceed productivity and quality standards
• Maintain knowledge of provider and member contracts, authorization requirements, InterQual Guidelines, medical policies, and clinical criteria
• Identify opportunities to connect members with appropriate Clinical Programs
• Collaborate with Customer Service/Claims Operations, Sales and Marketing, and Health Care Services
• Ensure Utilization Management decisions and turnaround times comply with accreditation and regulatory requirements
• Support the Plan’s Quality Program through quality improvement initiatives, programs, processes, studies, and projects

Utilization Review Clinician

Customer Support

• Provide inbound and outbound phone-based customer service
• Provide first-call and/or email resolution and de-escalate calls
• Educate callers through clear and accurate information exchange
• Follow up on, resolve, and document issues in a timely manner
• Route inquiries requiring further investigation to the appropriate department
• Conduct routine research, including claims-status research
• Follow up on pended items
• Route incoming paperwork to the correct departments
• Handle highly sensitive information while maintaining PPI requirements
• Meet performance goals, metrics, reliable behavior, and attendance expectations
• Serve Premera members and providers, including doctors, facilities, and vendors across multiple geographic locations
• Use ALICE, Premera’s AI-powered virtual agent, to access procedures and guidance

Customer Service Representative

Auditor

• Conduct retrospective and prospective audits of medical claims, provider billing, coding, and clinical documentation
• Validate CPT, HCPCS, ICD-10-CM, DRG, modifier, and revenue code accuracy and reimbursement compliance
• Apply medical terminology, anatomy, physiology, and disease-process knowledge when evaluating records
• Analyze billing trends and data to identify suspicious activity, improper reimbursement, and emerging risk
• Develop fraud prevention strategies and support provider education, remediation, and corrective action
• Independently investigate complex issues and recommend next steps
• Prepare audit findings, overpayment determinations, investigative documentation, and recommendations for leadership
• Maintain confidentiality, chain-of-custody standards, and compliance with applicable laws, regulations, and coding guidance
• Manage multiple audits and investigations, including priorities, timelines, deliverables, and stakeholder communication
• Collaborate with internal and external partners and provide affidavits or sworn testimony when needed
• Mentor junior auditors and lead process improvements and proactive audit initiatives